With systematic phenotyping, HeadSMART will facilitate diagnosis and risk-stratification of the heterogeneous group of individuals currently diagnosed with TBI.
Background:The RAPID [Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)] score is a validated scoring system which allows risk stratification in patients with pleural infection at presentation. Surgical intervention plays a key role in managing pleural empyema. Methods: A retrospective study of patients with complicated pleural effusions and/or empyema undergoing thoracoscopic or open decortication admitted to multiple affiliated Texas hospitals from September 1, 2014 to September 30, 2018. The primary outcome was all-cause 90-day mortality. The secondary outcomes were organ failure, length of stay and 30-day readmission rate. The outcomes were compared between early surgery (≤3 days from diagnosis) and late surgery (>3 days from diagnosis) and low [0-3] vs. high [4-7] RAPID scores.Results: We enrolled 182 patients. Late surgery was associated with increased organ failure (64.0% vs.45.6%, P=0.0197) and longer length of stay (16 vs. 10 days, P<0.0001). High RAPID scores were associated with a higher 90-day mortality (16.3% vs. 2.3%, P=0.0014), and organ failure (81.6% vs. 49.6%, P=0.0001).High RAPID scores with early surgery were associated with higher 90-day mortality (21.4% vs. 0%, P=0.0124), organ failure (78.6% vs. 34.9%, P=0.0044), 30-day readmission (50.0% vs. 16.3%, P=0.027) and length of stay (16 vs. 9 days, P=0.0064). High vs. low RAPID scores with late surgery was associated with a higher rate of organ failure (82.9% vs. 56.7%, P=0.0062), but there was not a significant association with mortality.Conclusions: We found a significant association between RAPID scores and surgical timing with new organ failure. Patients with complicated pleural effusions who had early surgery and low RAPID scores experienced better outcomes including decreased length of stay and organ failure compared with those who had late surgery and low RAPID scores. This suggests that using the RAPID score may help identify those who would benefit from early surgery.
Rationale E-cigarette, or vaping, associated lung injury (EVALI) is a new syndrome with unclear clinical course after discharge. It is unknown whether patients will have resolution of radiographic or pulmonary function test (PFTs) abnormalities. Whether severity of illness and length of stay are associated with increased risk of hospital readmission remains unknown. Methods We studied all patients diagnosed with EVALI at Intermountain Healthcare between June 1, 2019 and January 13, 2020. We reviewed PFTs, chest imaging, and symptoms of hospital survivors at follow-up, and assessed emergency department (ED) or urgent care (UC) usage within 30 days following discharge. We compared proportions using Fisher's exact test and compared central tendencies using Wilcoxon rank-sum. We performed univariate logistic regression to model the association between hospital and ICU length-of-stay and 30-day readmission. Results 114 patients were diagnosed with EVALI. 113 patients survived to discharge, 2 patients died within 30 days. 111 patients were 11 to 190 days post-discharge (Figure 1). At follow-up: 54 (of 111, 49%) had clinic follow-up with 35% (19) reporting residual symptoms at a median of 15.5 days (IQR 8-25); 43 (of 111, 38%) had follow-up chest x-rays with 51% (22) having residual abnormalities at a median of 22 days (IQR 14-47); 30 (of 111, 27%) had PFTs with 57% (17) having abnormal PFTs at a median of 29 days (IQR 12-49). We assessed 106 patients who were at least 30 days post-discharge for hospital readmissions, UC, and ED visits. 7% (7 of 106) patients were readmitted within 30 days. 14% (13 of 106) of patients had an ED or UC visit within 30 days. The majority of ED and UC visits were for pulmonary complaints (7 of 13, 54% within 30 days). The rest were for non-pulmonary causes. We found no association between receipt of ventilatory support (11% vs 3% p 0.124) or ICU admission (11%. vs. 4%, p = 0.22) during initial hospitalization and 30-day readmission. In univariate regression, hospital length of stay was associated with higher odds of readmission (OR 1.14, 95% CI 1.03-1.27, p = 0.013). Patients who were readmitted had longer hospitalizations (median 10 vs. 4 days, p = 0.0045) but not longer ICU stays (median 0 vs. 1.5 days, p = 0.18). Conclusion In patients diagnosed with EVALI, residual respiratory symptoms and abnormalities are common at short-term follow-up. Patients with longer hospitalizations are more likely to be readmitted in the subsequent 30 days.
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